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Reflux, Oversupply, Fore/Hindmilk Imbalance, etc.

I am getting so frustrated and I don't know what to do. I can't reach any of my local LLL leaders, since it's a holiday.

My son was born the end of May, so he is about 6 weeks old. I know this is a particularly difficult time in development, especially surrounding feeding issues. For the first three weeks of his life, he was unable to latch so I pumped and bottle fed. We hired a wonderful local LC and she got him latched on me the first try. I almost cried, I was so relieved. Since then, he has been getting better and better at nursing, until a few days ago.

He has been a pretty fussy baby all along and was diagnosed with reflux. The reflux hits him badly a couple of times a day and he just screams. We were giving Zantac, but I wasn't comfortable with it (and it didn't seem to help) so I quit. I also read that it really isn't effective in young babies because their digestion moves too quickly. A few days ago, on top of the reflux, he started having green, watery poop. I looked into it on the LLL FAQs and the description of oversupply and fore/hindmilk issues sounded just like my son. My right breast has always produced more milk when I pump, and has a much more forceful let-down. It will spray, but my left breast does not. When he has been nursing, especially on the right side, sometimes he gulps, coughs, pulls off, arches, cries, and refuses to nurse. He is very gassy and strains to pass gas and poop, sometimes crying from the effort. A-ha, I thought. So I tried block feeding, starting two nights ago.

At first it was wonderful. He was nursing a good long time, sleeping more peacefully (and longer), not fussing. His poop turned yellow again. But then yesterday evening he had a hysterical crying fit and absolutely refused to nurse. Arching, screaming painful cries, the whole thing. It was horrible. It went on for hours and I started feeing painful, hard spots in my breasts. My husband thawed some frozen breastmilk and finally the baby would take that. I tried pumping and massaging to relieve the pressure (I have had mastitis once and never want to go through that again), but nothing would come out the right breast. I got kind of frantic and my husband made me soak in a hot bath and try to express then. That worked enough to relieve the pressure.

Last night he nursed about every three hours, but did not stay on the breast as long as I am used to. I switched off from one side to the other for each new feeding. His poop is back to green, though, and he has been fussy this morning, straining with gas and sticking out his tongue like with reflux.

What can I do? Breastfeeding has been such a struggle for me. I am not willing to give it up, but I really don't know how to handle this.

Re: Reflux, Oversupply, Fore/Hindmilk Imbalance, etc.

Welcome! Our babies are about the same age. Mine was born at the beginning of May, which seems to be oversupply/OALD month...

First of all, how totally awesome that you got your baby to the breast after 3 weeks of bottles! That's a total triumph, and if you can hand in there I am sure it's eventually going to get better. Now, on to the reflux. My understanding is that when your baby has reflux bad enough to require medication, you often have to tinker with the dosage and with the type of medication in order to see a positive response. So maybe that's worth looking into?

So, the green poop. It's great that you seem to have figured out the OS/OALD riddle and started block feeding. It can take a while to tame a big supply, and it's sort of a 2 steps forward one step back problem- for me, block feeding would work for a while and then I'd go back to oversupply, just not quite as bad as before. And I would think "It's not working!" but with continued block feeding I eventually got where I wanted to be.

It sounds like last night your baby had a nasty fussy evening, and that led to some engorgement, and that in turn led to fast feedings (because there was so much milk and it came out so fast) and green poops. But don't despair! That was just one night, and it sounds like it was a "one step back" night. Just keep on block feeding, and things will improve.

Oh- and try a cup of peppermint or sage tea! They are supposed to help reduce supply.

Re: Reflux, Oversupply, Fore/Hindmilk Imbalance, etc.

What Mommal said!!

I found it helpful to get into a hot shower and let my milk come down, and spray all over the place, to take the edge off engorgement and (hopefully), the OALD. Pumping will make things worse (unless, maybe, just maybe, you can pump for just a few minutes, just to take the edge off, again - but I think those of us with enthusiastic boobs translate one minute of pumping into "Oh, dear, I have given birth to a whole football team, I better increase supply!!").

You are right - six weeks is a hard phase for almost everyone, and some babies really are a lot fussier than others during this time. All you can do is just keep on keepin' on. I didn't get my oversupply under control until about two months to 10 weeks. Of course, I made some major mistakes along the way, too. But, do not lose hope. I thought I would never sort it out, but even with goofing up continually along the way, my supply eventually regulated and my baby got big enough to handle the firehose/"boob bong" (as my husband called it). Before you know it, your baby will be gulping the milk down like a happy little frat boy.

ETA: The good thing about oversupply is that it's almost impossible to give up! You may WANT to give up sometimes, but your boobs won't let you. The only way out of your struggles is to keep nursing ... you'll get there.

You can call me JoMo!

Mom to baby boy Joe, born 5/4/09 and breastfed for more than two and a half years, and baby girl Maggie, born 7/9/12.

Re: Reflux, Oversupply, Fore/Hindmilk Imbalance, etc.

Thank you so much for your replies. It really does make a difference to hear from people who aren't going to tell me to just supplement with formula, or add rice cereal to whatever, or anything like that.

I am in a quandary about the pumping issue. I really want to pump once a day to freeze and store. I go back to work (teaching) in August and I want to have a good stock of frozen breastmilk by then for my husband to feed the baby. If it will really aggravate the problems I am having now, I will hold off, though. I currently have a very small supply in the freezer, and that makes me nervous.

Reflux is such a hard issue to cope with. The problem with Zantac is that for many people (especially infants), once the dose starts to wear off, the acid kicks up with a vengeance. The tendency is to increase and increase the dosage until it just doesn't work anymore. I am currently trying to keep him upright after feeding and giving probiotics and gripe water. We also gave in to him sleeping on his stomach. I know it's not recommended, but he can't sleep on his back. Once we put him on his stomach, our quality of life improved tenfold (I am only sort of exaggerating). During his next ped visit, I may ask the doctor about putting him on a PPI med. I am hoping he will improve by then, though.

Re: Reflux, Oversupply, Fore/Hindmilk Imbalance, etc.

but I think those of us with enthusiastic boobs translate one minute of pumping into "Oh, dear, I have given birth to a whole football team, I better increase supply!!").

had me !

I am in a quandary about the pumping issue. I really want to pump once a day to freeze and store. I go back to work (teaching) in August and I want to have a good stock of frozen breastmilk by then

I can totally understand why you have a quandary about this. Honestly, I think that it's wise to be thinking about your freezer stash. It always seems to be the teachers and the nurses who have the least time to maintain a pumping schedule. Are you in elementary ed, or high school?

I would try to live without the pumping for a week, and see what happens. If you see an improvement, then you can slowly add the pumping back in, one session at a time, backing off if you seem to be veering back into OS territory.

I am currently trying to keep him upright after feeding and giving probiotics and gripe water. We also gave in to him sleeping on his stomach. I know it's not recommended, but he can't sleep on his back.

I think keeping your baby upright, using probiotics and gripe water are a great way to cope with the reflux. And while some people may be all about tummy sleeping, I think that you do what you have to do. FWIW, my midwives were all "Oh phooey, it's a load of baloney" about the tummy sleeping recommendation.

During his next ped visit, I may ask the doctor about putting him on a PPI med. I am hoping he will improve by then, though.

Re: Reflux, Oversupply, Fore/Hindmilk Imbalance, etc.

As far as the pumping, maybe wait a few weeks before getting started on that stash? The other great thing about OS is that you really, really (hear me now) do not need to worry about having a big freezer stash. Most of my (ginormous, because my body was producing enough milk for an infant football team, right?) stash went to waste in the end. For a woman like you, who makes plenty of milk, you need enough back up to cover you for a day or two at most, in case some milk spills, or spoils. You don't need more than that, and if at some point, you decide you do, you will have no problem getting it with one or two extra pumpings on the weekend (early in the morning is always best for me). The normal rules (start pumping three to four weeks before you return to work) don't apply to OS mamas. So don't stress about that.

ETA: That's true about teachers, though. I can't understand how a profession that is predominantly women can be so unfriendly to mothers, but that's the fact. My friends who are teachers struggle to find time to pump. Still, if you'll get a couple breaks to pump, you'll probably be fine.

I take it you have tried sleeping your baby more upright, using a positioner or in a swing? That often works well for colicky babies. My baby did not have reflux, but he was very particular about sleeping. I had to swaddle him constantly and wear him in a sling - he wouldn't sleep without human contact. It was hard, and non-stop. While we didn't struggle with reflux specifically, my baby met the definition of "colic" for a couple weeks around the six week point. We just carried that baby nonstop. He did sleep better on his tummy, but I only let him do that on my chest, where I could monitor his breething - I was too paranoid to leave him alone on his tummy! When we could get him to sleep swaddled in a swing, it was like - VACATION! But it does get better.

Last edited by @llli*joe.s.mom; July 4th, 2010 at 10:55 AM.

You can call me JoMo!

Mom to baby boy Joe, born 5/4/09 and breastfed for more than two and a half years, and baby girl Maggie, born 7/9/12.

Re: Reflux, Oversupply, Fore/Hindmilk Imbalance, etc.

It looks like we've had one step forward, at least this afternoon and evening. There was some fussiness, but no melt down like yesterday. I was getting really concerned because of his very short nursing times, and he started fussing while on my left side. I noticed that the breast seemed very soft, so I switched sides and he nursed for about a half hour, the longest he has since yesterday morning. Now he's sleeping. Such a relief. I hope it continues into the night.

I'm a middle school teacher. 8th grade English/ESL. I love it! We have block scheduling, so I have an extended planning period mid-morning. I will definitely be able to pump daily during that time (the administration is typically very supportive of this kind of thing). I may have to lock my classroom door and cover the window, because we don't really have a good space for pumping at the school.

We don't have a swing, but we have tried a positioner. He just vastly prefers sleeping on his tummy. Currently, in the co-sleeper, we have put down a contoured changing pad. It just slightly raises on each side. He sleeps on that and there is no way he could end up with his face smashed against anything. The contouring keeps him away from the sides. We have tried swaddling him over and over, but from the first day of his life on, he has fought swaddling. He hates having his hands covered or restrained at all and will bust out of any swaddling attempt. He and I both love babywearing (I have slings, mei tais, wraps, you name it), but the heat here is intense to the point where wearing can be difficult. When we are in a cool place indoors, wrapping him either puts him in that calm, alert state or he goes right to sleep. Usually.

Re: Reflux, Oversupply, Fore/Hindmilk Imbalance, etc.

your story sounds a lot like mine, as bad as I feel for you, its kind of relieving to know that I am not the only one. I usually express out some before she gets on so shes not getting bombarded with milk or I take her off at letdown and give her a paci to soothe her until the milk is flowing at a slower rate. The hardest part for me is during the night and early morning hours because she sleeps longer so my left breast gets really hard with milk. Ive cried a many nights wanting to quit, but i just keep telling myself take it one day at a time. I pumped in the beginning but i found that it made things worse. I go back to work in August too, and I will start pumping I think closer to when I go back to work. About the reflux and the gassiness, try a side lying kinda position to burp and I keep my LO up for 30 minutes, and not like in a swing or anything positioned like for that upright burp. Also, i burp her several times on one breast, sometimes she gets angry and will scream but it gives her a break from the air when she does burp. She still spits up a lot but she seems to have less back arching and angry cries. She occasionally as the green poops too, but I just keep trying to express before feeds to let her have a better flow rate of milk. Hang in there, and keep telling yourself you are doing whats best for baby!!

Re: Reflux, Oversupply, Fore/Hindmilk Imbalance, etc.

Originally Posted by @llli*bitter.almond

Reflux is such a hard issue to cope with. The problem with Zantac is that for many people (especially infants), once the dose starts to wear off, the acid kicks up with a vengeance. The tendency is to increase and increase the dosage until it just doesn't work anymore. I am currently trying to keep him upright after feeding and giving probiotics and gripe water. We also gave in to him sleeping on his stomach. I know it's not recommended, but he can't sleep on his back. Once we put him on his stomach, our quality of life improved tenfold (I am only sort of exaggerating). During his next ped visit, I may ask the doctor about putting him on a PPI med. I am hoping he will improve by then, though.

My son has GERD and I had OALD, and the combination made for many tears from both of us during the first few months. I too had a lot of qualms about the medications prescribed for reflux, and tried not using any for awhile, then did medicate, then found a Chinese Medicine Practitioner whose treatments didn't stop the reflux but did seem to end the acid pain (at around 9 months). You can find some interesting information about the various reflux medications/doses at www.marci-kids.com, if you haven't already been there.

It is not uncommon for babies with reflux to only sleep well on their stomachs. My personal view of it is 1) if you imagine lying on your back and having fluid come up your throat while you are unable to move, it is easy to see why they prefer stomach sleeping, and 2) I believe that babies come with very strong survival instincts, and I personally have learned to trust those instincts. Preferences for sleeping positions, light sleeping, refusal to try solid foods -- these were things that appeared for me to be problems, until I came to understand my son's situation better, and I realized that they were all likely survival instincts at work.

Re: Reflux, Oversupply, Fore/Hindmilk Imbalance, etc.

Things seem to be going better! His poop is consistently yellow now. He is still showing some reflux symptoms, but they seem to be less severe. He also seems to be on a nursing MARATHON. He nursed forever last night, through the night, then for the better part of three hours this morning. I know some of it is just comfort sucking, but not all of it! Maybe it's that six week growth spurt.

He has two really cranky times now, one in the morning and one in the late afternoon or evening. One of our big challenges now is that whenever he is awake, he wants to be in arms or carrier. Always. I believe in attachment parenting, but sometimes I just need to put him down, which is apparently an outrage against Babykind.